How-to Guide: Multidisciplinary Rounds

1 How-to Guide: Multidisciplinary Rounds Updated Febru ary 2015 AN IH I RES OUR CE 20 University Road, Cambridge, MA 02138 How to Cite This Material: How-to Guide: Multidisciplinary Rounds . Cambridge, Massachusetts: Institute for Healthcare Improvement; February 2015. (Available at ) How-to GUIDE IHI s How-to Guides address specific health care interventions that hospitals and/or entire health systems can pursue to improve the quality of health care . How-to Guides present the key evidence-based care components for a particular topic, describe how to implement these interventions, and recommend measures to gauge improvement.

2 IHI initially developed How-to Guides as part of the 100,000 Lives Campaign and the 5 Million Lives Campaign. The Institute for Healthcare Improvement (IHI) is a leading innovator in health and health care improvement worldwide. For more than 25 years, we have partnered with visionaries, leaders, and front-line practitioners around the globe to spark bold, inventive ways to improve the health of individuals and populations. Recognized as an innovator, convener, trustworthy partner, and driver of results, we are the first place to turn for expertise, help, and encouragement for anyone, anywhere who wants to change health and health care profoundly for the better.

3 Copyright 2015 Institute for Healthcare Improvement. All rights reserved. Individuals may photocopy these materials for educational , not-for-profit uses, provided that the contents are not altered in any way and that proper attribution is given to IHI as the source of the content. These materials may not be reproduced for commercial, for-profit use in any form or by any means, or republished under any circumstances, without the written permission of the Institute for Healthcare Improvement. Institute for Healthcare Improvement 3 Contents Introduction 4 What Are Multidisciplinary Rounds ? 4 Why Is It Important to Conduct Multidisciplinary Rounds ?

4 5 Potential Impact of Multidisciplinary Rounds 5 Key Components of Reliable Multidisciplinary Rounds 6 Develop and Refine Your Aim for Rounds 6 The Structure of Rounds Is Essential 7 Leadership Is Key 7 Engage the Patient and Family 8 Measurement Matters 8 Examples of Success 9 Bon Secours St. Mary s Hospital, Richmond, Virginia 9 Santa Rosa Memorial Hospital, Santa Rosa, California 12 Using the Model for Improvement 13 Sample Small Tests of Change 14 Tips for Getting Started 14 Additional Tips for Implementing Multidisciplinary Rounds 15 Segment Patients 15 Script Questions 15 Spread Slowly 16 Expand Participation 16 References 17 How-to GUIDE.

5 Multidisciplinary Rounds Institute for Healthcare Improvement 4 Introduction Multidisciplinary Rounds , a model of care in which multiple members of the care team representing different disciplines come together to discuss the care of a patient in real time, have proven to be a valuable tool in improving the quality, safety, and patient experience of care . Many hospitals have achieved reduced patient days, reduced central line days, and increased coordination of care through the use of Multidisciplinary Rounds . Organizations that have been successful in implementing Multidisciplinary Rounds often start in the intensive care and critical care units, and conduct Multidisciplinary Rounds with multiple members of the care team (physicians, nurses, and ancillary clinicians and staff) seven days a week, developing daily goals for every patient.

6 Additionally, some hospitals have successfully invited families into their regular rounding process and have implemented Multidisciplinary Rounds on non-critical care units. What Are Multidisciplinary Rounds ? Multidisciplinary Rounds are a patient-centered model of care , emphasizing safety and efficiency, that enable all members of the team caring for patients to offer individual expertise and contribute to patient care in a concerted With Multidisciplinary Rounds , disciplines come together, informed by their clinical expertise, to coordinate patient care , determine care priorities, establish daily goals, and plan for potential transfer or discharge.

7 Many hospitals have reported improved communication and collaboration among members of the care team, more reliable adherence to process measures, and better patient outcomes through the use of Multidisciplinary Rounds . Although the effects of Multidisciplinary Rounds have not been heavily researched, formal peer-reviewed studies have found similar results. In one study, researchers at St. Luke s Hospital found that the adoption of Multidisciplinary Rounds in the medical intensive care unit resulted in improved process and outcome measures. For example, the use of Multidisciplinary Rounds has resulted in improved compliance with the IHI Ventilator Bundle and a significant decrease in ventilator-associated In another study, researchers studied the impact of a three-part intervention that included daily Multidisciplinary Rounds .

8 Here, the intervention resulted in a positive effect on the communication and collaboration among physicians and The importance of including pharmacists in daily Rounds has also been researched. Including a pharmacist on the ICU rounding team to make recommendations regarding dosage or frequency adjustments was found to significantly reduce adverse A study in Archives of Internal Medicine reports that Multidisciplinary care teams appear to be associated with a lower risk of death among patients in the intensive care unit . According to the authors, Multidisciplinary Rounds may facilitate implementation of best clinical practices such as evidence-based treatments for acute lung injury, sepsis, and prevention of ICU complications.

9 Pharmacist participation on Rounds is associated with fewer adverse drug events and alone may be associated with lower mortality among ICU patients. Multidisciplinary Rounds may also improve communication between health care providers. 4 How-to GUIDE: Multidisciplinary Rounds Institute for Healthcare Improvement 5 Why Is It Important to Conduct Multidisciplinary Rounds ? In its 2001 report, Crossing the Quality Chasm: A New Health System for the 21st Century, the Institute of Medicine identifies continuity of care as one of the key areas of concern in patient care Too frequently, decisions related to the care of a patient occur without input from the key providers, including nursing, pharmacy, social work, respiratory therapy, nutrition, physicians, physical therapy, and occupational therapy.

10 As a result, communication breakdowns occur, resulting in fragmented and poor quality care . Some key benefits of implementing Multidisciplinary Rounds are noted below. Effective Multidisciplinary Rounds can be a powerful vehicle for: o Coordinating care among disciplines o Reviewing current patient status o Clarifying patient goals and desired outcomes o Creating a comprehensive plan of care Multidisciplinary Rounds provide a formal mechanism for daily communication among the care team, patients, and families regarding: o Identification of safety risks o Identification of daily goals Multidisciplinary Rounds facilitate protocol or guideline use and understanding among the care team, providing.